Robert D. Wiens

Medical Care Costs and Quality of Life after Randomization to Coronary Angioplasty or Coronary Bypass Surgery

BACKGROUND Randomized trials comparing coronary angioplasty with bypass surgery in patients with multivessel coronary disease have shown no significant differences in overall rates of death and myocardial infarction. We compared quality of life, employment, and medical care costs during five years of follow-up among patients treated with angioplasty or bypass surgery. METHODS A total of 934 of the 1829 patients enrolled in the randomized Bypass Angioplasty Revascularization Investigation participated in this study. Detailed data on quality of life were collected annually, and economic data were collected quarterly. RESULTS During the first three years of follow-up, functional-status scores on the Duke Activity Status Index, which measures the ability to perform common activities of daily living, improved more in patients assigned to surgery than in those assigned to angioplasty (P<0.05). Other measures of quality of life improved equally in both groups throughout the follow-up period. Patients in the angioplasty group returned to work five weeks sooner than did patients in the surgery group (P<0.001). The initial mean cost of angioplasty was 65 percent that of surgery (

Medical Costs and Quality of Life 10 to 12 Years After Randomization to Angioplasty or Bypass Surgery for Multivessel Coronary Artery Disease

21,113 vs.

Chronotropic incompetence in clinical exercise testing

32,347, P<0.001), but after five years the total medical cost of angioplasty was 95 percent that of surgery (

Employment after Coronary Angioplasty or Coronary Bypass Surgery in Patients Employed at the Time of Revascularization

56,225 vs.

Effects of carbon monoxide exposure in patients with documented cardiac arrhythmias

58,889), a difference of

Utility of ambulatory electrocardiography in detecting pacemaker dysfunction in the early postimplantation period

2,664 (P = 0.047). The five-year cost of angioplasty was significantly lower than that of surgery among patients with two-vessel disease (

Ambulatory (Holter) electrocardiography and myocardial ischemia

52,930 vs.

Clinical correlates of the initial and long-term cost of coronary bypass surgery and coronary angioplasty

58,498, P<0.05), but not among patients with three-vessel disease (

Better Functional Status in American Than Canadian Patients With Heart Disease: An Effect of Medical Care?

60,918 vs.

Initial functional and economic status of patients with multivessel coronary artery disease randomized in the Bypass angioplasty revascularization investigation (BARI)

59,430). After five years of follow-up, surgery had an overall cost-effectiveness ratio of